W4: Stroke Flashcards
Define strokes and its aetiology
A stroke is a brain attack. It happens when the blood supply to part of the brain is cut off, killing brain cells. Damage to the brain can affect the way your body works, and it can also change how you think and feel.
What might be some of the perceived barriers of strokes patients in engaging in physical activity
Misconception of Physical Activity is bad
Lack of physical functioning to perform.
What are some of the physical activity treatment methods for stroke patients and what is the mechanism. Describe using recent literature and some of the improvements that physical activity could impose on stroke patients
Engaging in physical activity would obviously benefit these patients. One study conducted on stroke patients and the effects of treadmill walking activities 3x a week revealed that after 6 months, a significant improvement was seen on the VO2max whereas the %VO2max was unchanged in the same activity. This reveals that as a result of training, stroke patients would perceive the activities as less effortful and would be able to perform the activity with greater efficiency (Macko et al., 2005).
There is also systematic review evidence revealing that cardiorespiratory fitness increases as a result of physical activity in stroke patients where an increase of 3.5 ml/kg/min in VO2 max is revealed compared to not engaging in physical activity (Saunders et al., 2020). Another systematic review assessing moderate and vigorous intensity exercise modes effect on stroke patients revel a 2.2. ml/kg/min VO2max increase. In addition, walking activities were assessed and similar improvements were observed with a increase in perferred walking speed, maximum speed, and distance covered in 6min walk test (33.3m). Furthermore, exercise modes included seated activities such as cycle ergometer, and standing activities such as treadmill walking (Boyne et al., 2017).
Muscle strength can also be trained in stroke survivors. Dorsch et al., 2018) gathered literature to assess muscle strength improvements in stroke patients and revealed a significant overall increase in muscle strength.
Further away from the skeletal muscular and cardiorespiratory benefits, there are also psychococial benefits in engaging in physical activity as well. These includes a increasd self-efficacy, increased physical confidence and increased social confidence (Mead et al., 2004)
Give some recommendations for exercise in stroke patients
Stroke patients should aim to engage in both cardiorespiratory physical activity and resistance type physical activity.
In general, stroke patients should engage in at least 150min/week worth of moderate physical activity and 75min/week worth of vigorous physical activity. In particular, these exercises could include treadmill walking, brisk walking, cycle ergometers etc. Seated activities if appropriate. These should be performed in 20-60 minute bouts with a 10 minute warm-up and cool-down 3-5 days a week. The intensity should be around 11-14 on the RPE scale or 55-80% HRmax. (Billinger et al., 2014)
resistance training should be engaged at least 2x/week. Exercise could include free-weights, weight-bearing exercise, elastic bands etc. These could also be introduced in circuits to add on more intensity. These exercises should be performed in 10-15 repetitions and 1-3 sets of 8-10 exercises a day. 50-80% 1RM. If exercises start to feel comfortable increasing the resistance is recommended (Billinger et al., 2014). There is also an interesting study on increasing handgrip strength where isometric handgrip training 8 minutes squeezing 3 times per week actually reduces systolic blood pressure and decrease the rate of stroke by 22% (Smart et al., 2020)
Finally, some other physical activity that trains functional balance ad strength training should be implemented 3x per week at moderate to vigorous intensity. Reducing sedentary behaviour and replacing it with physical activity becomes important as well.
What are the most common types of strokes
85% from a brain infarction
What are the main problems that stroke survivors face regarding fitness levels
Overall, a low peakVO2max and leg muscle strength are main problems.
High amounts of sitting time and lower physical fitness (English et al., 2016). Compared to healthy controls, stroke patients spend significantly more time being sedentary. This and physical activity and daily expenditure were lower.
VO2 values are also extremely low. This means that activities would seem more effortful as they would require higher % VO2 max. These activities could correspond to things such as walking which could be more fatiguing and take longer times.
Stroke patients also have lower energy cost compared to healthy individuals. On one hand this could be interpreted as the stroke patients being more efficient with their energy used, however the true meaning would be due to the fact that stroke patients are slower in doing these activities resulting in a lower % VO2max (Blokland et al, 2017)
Furthermore stroke patients may possess lower extremity strength. In a study conducted measuring a stroke patient’s lower leg extensor power measuring both the affected leg and unaffected leg. The results revealed that the affected leg and unaffected leg were indifferent in the power output, however more interestingly, both of these legs were lower than the average age-matched leg strength. This result implied that daily inactivity was the main reasons to why a decline in lower leg strength was observed (Saunders et al., 2008). Hence these results also were factors of their comfortable walking speed and the chair rise times.
These inadequate fitness levels ultimately lead to inability to perform daily activities with ease and fatiguing quicker meaning that theres a threat to their safety
What do stroke patients redeem as important research in their lives?
Research areas in the order of balance & Walking, Fatigue, upper/lower extremity strength, exercise for rehabilitation, and lifestyle for secondary prevention were perceived as important to stroke survivors (Rudberg et al., 2020)
What are some psychological risk factors for a stroke?
In terms of indirect risk factors, social isolation and loneliness is understood to increase rates of stroke by 32% (Valtorta et al., 2016).
